Tuesday, April 19, 2011

5 Doula Myths Debunked

As doulas become more common on birth teams around the world, I get fewer blank stares when I tell people what I do. Most people have at least a nominal sense of what a doula does, even if the lines are a bit fuzzy for them. Over the years, however, I've noticed some common misconceptions about doulas and their role in birth. Because I hear these myths again and again, allow me to debunk a few for you.

Myth #1: A doula would interfere with the bond between my husband/partner and me in labor.

Your partner in life makes an ideal birth partner. He or she knows you best, and that bond can't be replaced by a doula - or anyone else - in labor. Doulas don't come into a birth and take over.

A good doula actually facilitates involvement. We can remind your partner about what you learned in class. Hips hurting? Here, I know a great technique for that. Dad, try this. We can also complement a partner's strengths. I've been to births where the dad fell into a really natural role as mom's physical support, and I offered more verbal reassurance. Even with great prep beforehand, he just might not know what to say.

Because we've studied and often seen a lot of births, doulas can be invaluable in unexpected situations. Has labor slowed down? Dad might not think about nipple stimulation, stair climbing, acupressure, visualization or thumb sucking (yes, thumb sucking). We also carry a great bag of tricks. My own doula bag includes goodies like tennis balls for counterpressure, peppermint oil to combat nausea, a gardening knee pad for kneeling dads, and mouthwash to refresh anyone on the birth team when mom's senses are incredibly heightened.

Doulas make sure dads take care of themselves too, with comfort measures and breaks during a long birth. Even the most amazing birth partner needs to eat and pee every once in awhile! We can reassure him when things are going normally, and help interpret and demystify hospital protocol. We're his doula too.

And finally, if the two of you are working beautifully together, we're skilled at backing off and letting that happen. I don't feel lost in moments of just observing. There's still real value in simply honoring and protecting a couple's birth space.

Myth #2: If I have a midwife, I don't need a doula.

Most of my clients birth with midwives. While it's true that doulas and midwives do share some common skills and goals, their roles are actually quite different. A doula is your sounding board from the minute you hire her. She'll help you process your hopes and fears about the pregnancy and birth, answer questions and connect you with resources. If you just need to talk every day for a week, she'll be there. You never have to wait for your next scheduled visit.

And unless you're having a homebirth, even the best midwife won't meet you in your living room and support you through early labor. Doulas often connect with their clients at home, laboring with them there, and helping them with the transition to the hospital or birth center. After arriving at your birth place, a midwife can't guarantee you'll be her only patient in labor. Your doula is there for you, and only you.

Midwives offer birth knowledge and suggestions for coping with labor, as do doulas. However, a midwife's final responsibility rests with the health of mom and baby. At a certain point in almost every birth (and sometimes at many points), a midwife must turn her attention from support to the medical aspects of birth. She watches for complications, advises on interventions or approaches, and serves as medical guardian.

A doula doesn't perform any clinical tasks and stays focused solely on support. She nurtures you in the calm and beautiful spells, and also if there are any frantic, scary moments. "You're doing such an amazing job, this is normal." "I trust your decision-making process." "Stay strong, you're almost there." "Listen to your body." "Don't be scared, we're here with you."

Myth #3: My doula will protect me against the hospital staff.

Not even the best doula can "save" a couple from an interventionist doctor, midwife or hospital. It is up to you to advocate for yourselves, and make your wishes known to the staff.

First of all, a doula can be kicked out of a birthing room very quickly if she steps on any toes. Second, we might have to work with these same people again next week or next month—to serve our clients well, it's best not to have an antagonistic relationship.

That's not to say that a doula can't play a more subtle advocacy role. The first thing we might do is to help you figure out if the practice you're with is a good match for your birth goals, and if not, help identify another provider who might be more complementary. We'll also encourage you to talk with your provider about all your hopes and expectations beforehand, so there's less chance of any surprise at the actual birth.

During birth, we can remind you of your birth plan, share what we know about options, suggest questions, and help you sort through your feelings and priorities. I've also given couples a gentle "heads up" when I've seen a medical intervention about to be performed without their consent. And when the pressure is on to make a medical decision, assuming it's not an emergency, a doula can suggest some time alone to think and talk. Just removing the pressure of someone standing over you, waiting for an immediate answer, can help a couple think through their options and priorities with clear heads.

Myth #4: I can't afford a doula.

We spend incredible amounts of money on preparing for a baby in this country. Dare I say it, many of those dollars go toward unnecessary accoutrements. Pretty much, for a newborn, you need diapers, some onesies and a breast. A sling is handy. That's it. Your baby will never miss that fancy diaper stacker, sticker-shock crib, or those adorable matching baskets. By comparison, women process their births for their entire lives. And unnecessary interventions can have long-lasting emotional and physical effects for mom and baby. We get one chance to birth our babies. So for many couples, affording a doula is merely a matter of shifting priorities.

In almost every community, if you truly want birth support, there is a doula in your price range. Doula work is demanding and doesn’t usually pay very well. Still, many are willing to adjust their fees on a sliding scale for low-income mothers. Bartering and payment plans are also common. If the doula you first approach doesn't do pro-bono work, or has reached her limit, she can usually help connect you with a new doula who will work at a very low cost as she gains experience. Call doula certifying organizations like DONA International for a list of doulas working toward certification, or visit DoulaMatch and DoulaConnect to find doulas working in your state and local area.

Myth #5: All doulas wear patchouli and long skirts and they only like natural birth.

This one's easy to debunk, since I'm living proof. Patchouli gives me a headache, and I can't remember the last time I wore a skirt. Some doulas are crunchy, some look a lot like your grandma or your banker, and some of us are more of the soccer-mom set.

As for going natural, you can find doulas who had medicated births or cesarean births themselves. Many doulas feel comfortable supporting any couple, no matter what kind of birth they're hoping for.

Others, and I include myself in this group, have a true love for natural birth, but also a strong sense of compassion for women faced with challenging situations or true medical complications. We're not in your body, and we can't completely know what the labor experience is like for you. Medications and interventions, while vastly overused, certainly have their place. The core of a doula's role is support - support for your decision-making process and your innate wisdom about the best path for your birth. I've witnessed some truly beautiful births that included Pitocin, narcotics, epidurals, and even c-sections.

A good doula nurtures and supports you on your birth journey, wherever it leads you. One of my clients told me after her VBAC that during her birth she felt surrounded in love. That's much more important to me than whether someone experiences my idealized version of a "perfect birth." If every family I work with feels surrounded in love, I've done my job.

Jessica English is a doula, natural childbirth instructor and the owner of Birth Kalamazoo. Her two boys were both born naturally into their daddy's hands, one in the hospital and one at home. She had doula support for both journeys, of course. Jessica moonlights in freelance writing and public relations, but feels lucky to call birth her day (and night) job.

10 comments:

I had a doula, because I am type I diabetic so I was told I had to have my baby at the hospital (though, I might contest that with my fourth!). She was amazing! I highly recommend a doula. She helped me learn so much that I didn't know before hand. She became a good friend because we spent a lot of time together preparing and then she would visit after I had the baby. She is our angel and my whole family loves her! LOVE YOU CAITLIN!!

as an L&D nurse there is no one I'm happier to see with a laboring mom than her doula. Makes my life so much easier as she can tell me what their plan was while mom is breathing/moaning/vomiting.... I have "had words" with a few, but far less than I've "had words" with obstetricians! My role is patient advocate, but I can't really fulfill that role unless I know what you want, Doulas do a nice job of facilitating that.

I am a trained birth doula (although not currently active) and I had a doula at each of my births. Both were hospital births. The first with my CNM, the 2nd with the on-call doc from my OB-GYN practice. I needed my husband and doulas for both births to fulfill different roles. As a matter of fact, when I got pregnant with #2, hubby said, "We're getting a doula, right?!?!" ☺

Bottom line is that there are no negatives to having a good, positive, trained support person by your side throughout the birthing process! And thank you to State of Grace on her comments as a L&D nurse!!!

This was a great piece! That you so much for sharing. We have a friend who is a doula and she accidently ended up being at the hospital with us for the birth of our son. Let me tell you, I was so incredibly grateful that she was there! I had no idea how helpful a doula really can be! When things went downhill, my extremely supportive husband was so appreciative of her knowledge. Great post!

I had the same doula for all 4 of my births, and she was amazing. We had considered not having her for our 4th birth assuming that we had it down by then, but my husband talked me into it. My labor stalled at 8 cm, and we never needed her support and suggestions more. We got through it, but doubt that we would have without her. Doulas are invaluble!

I guess we're lucky here in New Zealand - (or I just have an unusual midwife) because she does ALL the things you mention in myth #2. All prenatal visits are in my home (homebirth - so it makes sense), lasting between 1.5-2hrs where we spend time getting to know each other, discussing concerns/fears etc. She is on call to speak to me whenever I need it, and it very hands on/physical with support. I love the idea of a Doula, but here in NZ there aren't many. Thank goodness I have a good midwife and a good friend to support my partner and I instead.